Applications of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in pulmonary disease

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive mediastinal staging tool for lung cancer but also a diagnostic tool for mediastinal lesions near the airway. This review focuses primarily on the technique of linear probe EBUS-TBNA itself, training and financial issues, indications and performance, and pros and cons compared to other mediastinal sampling techniques. As such, it is relevant to centres considering to establish an EBUS-TBNA service. EBUS-TBNA is the most commonly used for staging non-small cell lung cancer (NSCLC), particularly bulky mediastinal lymphadenopathy and enlarged N2 or N3 disease on CT, but is also used for the diagnosis of unexplained mediastinal lymphadenopathy of other causes. For staging when radical treatment is contemplated, many centres still perform mediastinoscopy and this should be done in order to corroborate negative EBUS-TBNA results in this setting or when the pre-test clinical probability of lung cancer is high. EBUS-TBNA may be used in the future for staging, when the mediastinal nodes are normal according to radiological staging and also in re-staging. EBUS-TBNA can be learned with appropriate training and mentorship; it offers numerous advantages over mediastinoscopy and can reduce costs by avoiding mediastinoscopy (and the required peri-operative support) in many cases.